Small gauge surgical instrument with adjustable support

ABSTRACT

A small gauge surgical instrument is shown with advantages such as diminished “play” at the tip. A surgical instrument assembly is also shown with support along a length of the instrument that can be selected by the surgeon. Devices and method described provide adjustability of the instrument without protruding into a gripping surface of the instrument.

CLAIM OF PRIORITY

This patent application is a continuation of and claims the benefit ofpriority under 35 U.S.C. § 120 to U.S. patent application Ser. No.13/628,806, filed on Sep. 27, 2020, which claims the benefit ofpriority, under 35 U.S.C. § 119(e), to U.S. Provisional PatentApplication Ser. No. 61/539,655, entitled “SMALL GAUGE SURGICALINSTRUMENT WITH ADJUSTABLE SUPPORT,” filed on Sep. 27, 2011, each ofwhich is hereby incorporated by reference herein in its entirety.

TECHNICAL FIELD

This invention relates to small gauge instruments typically used forsurgical procedures such as surgery of the eye.

BACKGROUND

Ophthalmological surgery continues to evolve towards smaller instrumentsthat produce smaller incisions. The most common incision size currentlyis 20 gauge (approximately 1.0 mm diameter), but newer instruments assmall as 27 gauge (approximately 0.41 mm diameter) are being utilized,and smaller instruments are likely in the future. The advantages ofsmaller incisions are multiple, including lessened trauma, fasterhealing, faster wound management (no sutures), and greater patientcomfort.

Problems exist with the smaller instruments, however. The small diameterof the instruments makes them quite flexible, which is a disadvantagefor the surgeon. With larger diameter instruments, there is very little“play”, so the tips of the instruments go exactly where the surgeondesires that they go. With the smaller diameter instruments, the tipscan move from their intended positions due to the bending or flexing ofthe fine wire-like instruments, which makes the surgeon feel a loss ofcontrol.

Bending or flexing of the small instruments is of particular concern insome procedures, for example, removal of peripheral vitreous, when theeye must be turned to allow viewing by the surgeon. Turning of the eyeis accomplished by moving the instrument relative to the patient's headwhile a portion of the instrument remains inserted within a portion ofthe eye. Because the amount of flexing of the instrument is relativelylarge and unpredictable to the surgeon, precise repositioning of the eyebecomes more difficult. In addition, delicate maneuvers such as peelingmembranes from the retinal surface become significantly more difficultwhen instruments are too flexible causing imprecision of movements.

What is needed is an instrument design that accommodates increasinglysmall diameters, and still provides precise control without unwantedflexing.

OVERVIEW

The present instruments, and related methods provide means fordiminishing the “play” in very small and flexible instruments, such asinstruments for ophthalmological surgery. Embodiments described includedesigns where characteristics such as stiffness can be adjusted by asurgeon. Embodiments described also include adjustments so access ispossible to all parts of the vitreous cavity. Embodiments described alsoinclude an adjustment mechanism where a level of support of a smalldiameter instrument can be varied, yet a number of supply lines remainlocated in a central part of a base unit, and the support frame iscontained within a substantially continuous gripping surface of the baseunit.

To better illustrate the instruments, and related methods disclosedherein, a non-limiting list of examples is now provided:

In Example 1, an ophthalmologic instrument includes a base unit having alateral gripping surface, a small diameter instrument extending from thebase unit, the small diameter instrument having a length, one or moresupply lines routed through an interior of the base unit to the smalldiameter instrument, a support frame slidably coupled to the smalldiameter instrument along the length, and an adjustment mechanism forthe support frame, to provide two or more different levels of lateralsupport to the small diameter instrument, wherein the support fame isspaced apart from the one or more supply lines, and contained within thelateral gripping surface.

In Example 2, the ophthalmologic instrument of Example 1 is optionallyconfigured such that the adjustment mechanism includes one or more rodsthat slide within holes in the base unit.

In Example 3, the ophthalmologic instrument of any one or anycombination of Examples 1-2 is optionally configured such that theadjustment mechanism includes a scale on a side of a rod to indicate thedifferent levels of lateral support.

In Example 4, the ophthalmologic instrument of any one or anycombination of Examples 1-3 is optionally configured such that theadjustment mechanism includes a threaded knob to adjust the levels oflateral support.

In Example 5, the ophthalmologic instrument of any one or anycombination of Examples 1-4 is optionally configured such that theadjustment mechanism includes a flexible cable between the threaded knoband the one or more rods.

In Example 6, the ophthalmologic instrument of any one or anycombination of Examples 1-5 is optionally configured such that the oneor more supply lines includes a supply line chosen from a groupconsisting of fiber optics, media infusion, suction, and drug, or otherfluid delivery.

In Example 7, the ophthalmologic instrument of any one or anycombination of Examples 1-6 is optionally configured such that the oneor more supply lines includes a supply line to deliver an instrumentchosen from a group consisting of cutting tools, forceps, and scissors.

In Example 8, the ophthalmologic instrument of any one or anycombination of Examples 1-7 is optionally configured such that thesupport frame includes a cylinder that fits closely around the smalldiameter instrument.

In Example 9, the ophthalmologic instrument of any one or anycombination of Examples 1-8 is optionally configured such that the smalldiameter instrument is approximately 23 gauge or smaller in diameter.

In Example 10, the ophthalmologic instrument of any one or anycombination of Examples 1-9 is optionally configured such that the smalldiameter instrument is approximately 25 gauge in diameter.

In Example 11, the ophthalmologic instrument of any one or anycombination of Examples 1-10 is optionally configured such that thesmall diameter instrument is approximately 27 gauge in diameter.

In Example 12, a method includes gripping a substantially continuouslateral surface of a base unit of an instrument, adjusting a supportdevice along a length of a hollow instrument having a diameter of 23gauge or less to select a level of lateral support, and applying lateralforce with the small diameter instrument, wherein the support deviceenhances lateral stiffness of the small diameter instrument.

In Example 13, the method of Example 12 is optionally provided such thatadjusting the support device along the length of the hollow instrumenthaving a diameter of 23 gauge or less includes adjusting a supportdevice along a length of a hollow instrument having a diameter ofapproximately 25 gauge.

These and other examples and features of the instruments, and relatedmethods will be set forth in part in the following detailed description.This overview is intended to provide non-limiting examples of thepresent subject matter—it is not intended to provide an exclusive orexhaustive explanation. The detailed description below is included toprovide further information about the present instruments, and methods.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a side view of an instrument according to an embodiment ofthe invention.

FIG. 2 shows a top view of the instrument from FIG. 1, according to anembodiment of the invention.

FIG. 3 shows another instrument according to an embodiment of theinvention.

FIG. 4 shows a method of using an instrument according to an embodimentof the invention.

DETAILED DESCRIPTION

In the following detailed description, reference is made to theaccompanying drawings which form a part hereof, and in which is shown,by way of illustration, specific embodiments in which the invention maybe practiced. In the drawings, like numerals describe substantiallysimilar components throughout the several views. These embodiments aredescribed in sufficient detail to enable those skilled in the art topractice the invention. Other embodiments may be utilized andstructural, or logical changes, etc. may be made without departing fromthe scope of the present invention.

FIG. 1 shows an instrument 100 including a small diameter instrument110, and a support device 120. The small diameter instrument 110includes a distal end 112 and a proximal end 114. In one example, thesmall diameter instrument 110 includes a hollow tube. In one example,the small diameter instrument 110 has a diameter smaller than 20 gauge.In one example, the small diameter instrument 110 has a diameter equalto, or smaller than 23 gauge. In one example, the small diameterinstrument 110 has a diameter of approximately 25 gauge.

The small diameter instrument 110 is shown extending from a base unit101. The base unit 101 includes a lateral gripping surface 102. During aprocedure, it is desirable to have the gripping surface 102 free fromprotrusions, or controls that may interfere with a surgeon's grip of thebase unit 101. In one example, the base unit 101 is configured to be thesame size and shape of a base unit in existing ophthalmological devices.It is desirable to make the base unit 101 of the present disclosure moveand feel the same as existing base units, with added features, such asadjustable support.

One or more supply lines 106 are shown extending into the base unit 101and routed through an interior of the base unit 101. In one example, oneor more of the supply lines 106 includes a fiber optic supply line, suchas general illumination, or a laser for drug activation, cauterization,ablation, etc. In one example, one or more of the supply lines 106includes a passage for infusion of a media such as liquid, gas, orsupply of a drug, or a passage for suction of material. In one example,one or more of the supply lines 106 includes an introducer for aninstrument such as a cutting tool (e.g. scissors, blade, etc.) or othertools such as forceps, probes, etc.

In one example, it is desirable to route supply lines throughapproximately a center of the base unit 101 for ease of manufacture, andease of use. Configurations described below provide adjustableproperties of the instrument 100 to the surgeon without affectinglocation of the supply lines 106, or protruding outside of the grippingsurface 102.

The small diameter instrument 110 and the support device 120 areadjustable relative to each other, allowing the surgeon to selectivelyprovide support at different locations along a length of the smalldiameter instrument 110. Although “gauge” is used to define a size ofthe small diameter instrument, the invention is not limited to circularcross section instruments. When referring to non-circular small diameterinstruments, an average diameter can be used to define a gauge.

In one example, a support device 120 of adequate stiffness is positionedalong the shaft of the small diameter instrument 110 (25 gauge or thelike). The support device 120 stabilizes the instrument so the surgeonusing it has a greater sense of security regarding the position of thetip inside the eye. The support device 120 is adjustable so that thefull length of the small diameter instrument 110 can be selectivelyinserted into the eye for posterior work. Posterior work typicallyrequires minimal twisting motion by the surgeon, therefore a lower needfor stabilization.

For a procedure that will benefit from more support, such as aperipheral vitrectomy, the support device 120 can be moved down theshaft of the small diameter instrument 110 to provide increased support.With the support device 120 moved closer to the distal end 112, lessplay is present at the distal end 112 of the small diameter instrument110 when the eye is twisted and turned by the surgeon.

In one example, the support device 120 design includes a sliding portion122 having a close tolerance fit with the small diameter instrument 110,to allow adjustment of support, while minimizing lateral motion of thesmall diameter instrument 110 within the sliding portion 122. In oneexample, a 20 gauge cylinder is used as a sliding portion 122. Thesliding portion 122 may be constructed of a strong material such asstainless steel, to go around the small diameter instrument 110. Thesliding portion 122 is attached to an adjustment mechanism, includingone or more rods 126 that runs parallel to the small diameter instrument110. In one example the sliding portion 122 is attached to the rods 126using a coupling member 124. FIG. 1 shows the rods 126 slidably movingwithin holes 104 in the base unit 101. A control 130, coupled to the oneor more rods 126 is pushed or pulled to move the sliding portion 122along the length of the small diameter instrument 110 to adjust a levelof lateral support.

In one example, a scale 128 such as gradated lines, or other indicia areincluded to indicate a relative position of the sliding portion 122 withrespect to the length of the small diameter instrument 110. Examplesthat include the scale 128 provide an indication of the different levelsof lateral support provided to the small diameter instrument 110.

In one example the one or more rods 126 are interference tolerancedwithin the holes 104 to provide a level of friction that holds thesupport device 120 in a selected position with respect to the smalldiameter instrument 110. The friction provided by the interferencetolerance is high enough to hold the support device 120 in place, once alevel of support is selected, yet the level of friction is low enough,such that the surgeon can overcome the friction to make subsequentsupport adjustments.

In one example, the adjustment mechanism includes a positioning system108, such as mating detents, ratchets, or the like provide a selectionof the level of support by location of the support device 120 withrespect to the small diameter instrument 110. Systems such as detents orratchets, etc. provide tactile feedback to the surgeon, that along withthe scale 128 are easy to operate and know when an adjustment has beenmade.

FIG. 2 shows an end view of the instrument 100 from FIG. 1. The smalldiameter instrument 110, with the sliding portion 122 is shown inapproximately the center of the base unit 101. The rods 126 are showncoupled to the sliding portion 122 by the coupling member 124. Theexample shown in FIG. 2 illustrates a solid disk shaped coupling member124, however one of ordinary skill in the art, having the benefit of thepresent disclosure, will recognize that other configurations such asstruts, or complex shaped coupling members 124 are within the scope ofthe invention.

Three approximately equally spaced rods 126 are shown in FIG. 2,although other numbers of rods 126 are within the scope of theinvention. Three substantially equally spaced rods are a stableconfiguration, providing support on three axes for increased stabilityand control.

FIG. 3 shows another embodiment of an instrument 200. Only selectedfeatures of the instrument 200 are discussed in detail. In selectedexamples, features that are described above regarding instrument 100 canalso be incorporated into instrument 200. In FIG. 3, a small diameterinstrument 210 and a support device 220 are shown. The small diameterinstrument 210 is shown extending from a base unit 201. The base unit101 includes a lateral gripping surface 202.

The small diameter instrument 210 includes a distal end 212 and aproximal end 214. Similar to the instrument 100 from FIGS. 1 and 2, inone example, the small diameter instrument 210 includes a hollow tube.In one example, the small diameter instrument 210 has a diameter smallerthan 20 gauge. In one example, the small diameter instrument 210 has adiameter equal to, or smaller than 23 gauge. In one example, the smalldiameter instrument 210 has a diameter of approximately 25 gauge.

The support device 220 of the instrument 200 in FIG. 3 includes asliding portion 222 having a close tolerance fit with the small diameterinstrument 210, to allow adjustment of support, while minimizing lateralmotion of the small diameter instrument 210 within the sliding portion222. The sliding portion 222 is attached to an adjustment mechanism,including one or more rods 226 that runs parallel to the small diameterinstrument 210. In one example the sliding portion 222 is attached tothe rods 226 using a coupling member 224. FIG. 3 shows the rods 226slidably moving within holes 204 in the base unit 201.

In the example of FIG. 3, the rods 226 do not extend all the way throughthe base unit 201. Ad adjustment mechanism 230 is shown, including aknob 240 that is coupled to the one or more rods 226 to move the slidingportion 222 along the length of the small diameter instrument 210 toadjust a level of lateral support. FIG. 3 shows a threaded portion 232of the knob 240 that moves within a mating thread pocket 234, andprovides precise control of the position of the sliding portion 222along the length of the small diameter instrument 210. A cable 236, orother connection is provided between the threaded portion 232 and one ormore rods 226. Use of a flexible connection such as a cable 236 allowsthe knob 240 to be offset laterally from the rod 226, as shown in FIG.3.

When the knob 240 is rotated a desired amount, the cable 236 is movedwithin a passage 238 and in turn, actuates the rod 226. In one example,the threaded portion 232 provides 10 mm of available travel whichtranslates through the cable 236 and the rod 226 to a position of thesliding portion 222 along the length of the small diameter instrument210. In one example, a bearing, or other rotation joint is included inthe linkage between the knob 240 and the sliding portion 222. In oneexample the cable 236 is coupled at location 242 in such as way as topush and pull the rod, while a bearing or other rotation joint allowsthe cable to rotate with respect to the rod 226, to permit adjustment ofthe sliding portion 222 along the length of the small diameterinstrument 210.

As in the instrument 100 of FIGS. 1 and 2, in one example, a scale 228such as gradated lines, or other indicia are included to indicate arelative position of the sliding portion 222 with respect to the lengthof the small diameter instrument 210. In one example, threeapproximately equally spaced rods 226 are used in the support device220, although other numbers of rods 226 are within the scope of theinvention. Three substantially equally spaced rods are a stableconfiguration, providing support on three axes for increased stabilityand control.

Both example instruments 100 and 200 illustrate an adjustment mechanismwhere a level of support of the small diameter instrument can be varied,yet the number of supply lines remain located in a central part of thebase unit, and the support frame is contained within a substantiallycontinuous gripping surface of the base unit. No adjustment controlsprotrude through the substantially continuous gripping surface.

FIG. 4 shows a flow chart of an example method of operating a supportdevice, such as a support device described in examples above. Operation402 describes gripping a substantially continuous lateral surface of abase unit of an instrument. Operation 404 describes adjusting a supportdevice along a length of a hollow instrument having a diameter of 23gauge or less to select a level of lateral support. Operation 404describes applying lateral force with the small diameter instrument,wherein the support device enhances lateral stiffness of the smalldiameter instrument.

Instruments are shown which diminish the “play” in very small andflexible instruments, such as instruments for vitreous surgery.Embodiment described above include designs where characteristics such asstiffness can be adjusted by the surgeon. Embodiments described abovealso include adjustments so access is possible to all parts of thevitreous cavity. Embodiments as shown above provide features to makesurgical procedures safer. Embodiments described above also increase thevariety of cases for which small, more flexible instruments can be used.Although vitreous surgery is discussed above as an example procedure,embodiments of the invention described above and in the following claimsare not so limited. Other surgical procedures will also benefit from theadvantages that these device configurations provide.

While a number of advantages of embodiments described herein are listedabove, the list is not exhaustive. Other advantages of embodimentsdescribed above will be apparent to one of ordinary skill in the art,having read the present disclosure. Although specific embodiments havebeen illustrated and described herein, it will be appreciated by thoseof ordinary skill in the art that any arrangement which is calculated toachieve the same purpose may be substituted for the specific embodimentshown. This application is intended to cover any adaptations orvariations of the present invention. It is to be understood that theabove description is intended to be illustrative, and not restrictive.Combinations of the above embodiments, and other embodiments will beapparent to those of skill in the art upon reviewing the abovedescription. The scope of the invention includes any other applicationsin which the above structures and fabrication methods are used. Thescope of the invention should be determined with reference to theappended claims, along with the full scope of equivalents to which suchclaims are entitled.

What is claimed is:
 1. An ophthalmologic instrument, comprising: a baseunit having an outer surface lateral to a longitudinal axis, with noprotrusions or controls on the outer surface lateral to the longitudinalaxis of the base unit; a small diameter instrument fixed in relation tothe base unit, and extending from the base unit, the small diameterinstrument having a length; a support frame slidably coupled to thesmall diameter instrument along the length; an adjustment mechanism forthe support frame, to provide two or more different levels of lateralsupport to the small diameter instrument, wherein the adjustmentmechanism is located on a surface other than the outer surface lateralto the longitudinal axis of the base unit; and wherein the support frameis spaced laterally apart from the small diameter instrument, andcontained within the outer surface lateral to the longitudinal axis. 2.The ophthalmologic instrument of claim 1, wherein the adjustmentmechanism includes one or more rods that slide within holes in the baseunit.
 3. The ophthalmologic instrument of claim 1, wherein theadjustment mechanism includes a scale on a side of a rod to indicate thedifferent levels of lateral support.
 4. The ophthalmologic instrument ofclaim 1, wherein the adjustment mechanism includes a threaded knob thatmoves within a threaded mating pocket on the base unit to adjust thedifferent levels of lateral support.
 5. The ophthalmologic instrument ofclaim 4, wherein the adjustment mechanism includes a flexible cablebetween the threaded knob and the one or more rods.
 6. Theophthalmologic instrument of claim 1, wherein the small diameterinstrument includes a fiber optic instrument.
 7. The ophthalmologicinstrument of claim 1, wherein the small diameter instrument includes aninfusion cannula.
 8. The ophthalmologic instrument of claim 1, whereinthe small diameter instrument includes a cutting tool.
 9. Theophthalmologic instrument of claim 1, wherein the small diameterinstrument includes a forceps.
 10. The ophthalmologic instrument ofclaim 1, wherein the small diameter instrument includes a probe.
 11. Theophthalmologic instrument of claim 1, wherein the support frame includesa cylinder that fits closely around the small diameter instrument. 12.The ophthalmologic instrument of claim 1, wherein the small diameterinstrument is approximately 23 gauge or smaller in diameter.
 13. Theophthalmologic instrument of claim 1, wherein the small diameterinstrument is approximately 2.5 gauge in diameter.
 14. Theophthalmologic instrument of claim 1, wherein the small diameterinstrument is approximately 27 gauge in diameter.
 15. An ophthalmologicinstrument, comprising: a base unit having an outer surface lateral to alongitudinal axis, with no protrusions or controls on the outer surfacelateral to the longitudinal axis of the base unit; a small diameterinstrument fixed in relation to the base unit, and extending from thebase unit, the small diameter instrument having a length; a supportframe slidably coupled to the small diameter instrument along thelength; an adjustment mechanism for the support frame, including aplurality of rods that extend both proximally and distally through thebase unit, to provide two or more different levels of lateral support tothe small diameter instrument, wherein the adjustment mechanism islocated on a surface other than the outer surface lateral to thelongitudinal axis of the base unit; and wherein the support frame isspaced apart from the small diameter instrument, and contained withinthe outer surface lateral to the longitudinal axis.
 16. Theophthalmologic instrument of claim 15, wherein the adjustment mechanismincludes three or more rods that slide within holes in the base unit,wherein the three or more rods form a stable configuration providingsupport on three axes for stability and control.
 17. The ophthalmologicinstrument of claim 15, wherein the outer surface lateral to thelongitudinal axis includes a concave surface to facilitate gripping. 18.The ophthalmologic instrument of claim 15, wherein the small diameterinstrument includes a fiber optic instrument.
 19. The ophthalmologicinstrument of claim 15, wherein the small diameter instrument includesan infusion cannula.
 20. The ophthalmologic instrument of claim 15,wherein the small diameter instrument includes a cutting tool.
 21. Theophthalmologic instrument of claim 15, wherein the small diameterinstrument includes a forceps.
 22. The ophthalmologic instrument ofclaim 15, wherein the small diameter instrument includes a probe.